Preventing violence — caring for victims

Part of the great tradition of surgery, exemplified by the Royal College precept, ‘From Here Health’, is that surgeons are committed to prevention as well as cure. King James IV and his able contemporary in China, where this lecture was delivered, Emperor Hongzhi, would have approved of it. This tradition has, perhaps, been neglected since the emergence of public health as a medical specialty. However, opportunities and reasons for surgeons to contribute to prevention have never been greater. Community violence prevention — increasing public safety in the towns and cities in which surgeons work — is an example. Primary prevention of injury achieved by collecting and sharing unique information about weapons and the locations of assault, secondary prevention achieved by combining wound care with motivational interviewing to reduce alcohol misuse, and tertiary prevention achieved by early referral to mental health professionals for treatment of post-traumatic stress, have been integrated into a new care pathway which combines prevention with surgical care. Individuals and communities would benef t substantially if every surgical specialty incorporated prevention — a professionally highly-rewarding activity — into its training curriculum.